What Happens When Active Shooter Best Practices Aren't Good Enough?

In the forward-thinking circles of the law enforcement profession, we pride ourselves on being data-driven. Data provides us the ability to identify problems and the foundation for objective analysis of our success in solving those problems. Whether it’s crime, traffic, or recruiting and retention, we use data to figure out what is working and what is not.?

At the same time, good law enforcement agencies also pride themselves on following best practices– and with good reason:? best practices are the widely accepted standard of what right looks like.

But sometimes the data tells us that best practices aren’t getting the desired results. At that point, a responsible profession’s path forward is to find a better way. After all, best practices are only best practices until we find better practices.?

Falling Short

One place where the data is forcing us into an uncomfortable conversation is the high-value realm of active shooter response. In 2019, The American College of Surgeons (ACS) published a study that looked at 213 victims of mass-shootings between 1999 and 2017. What they found was that nearly 1 in 5 victims died of what were essentially survivable wounds– what the authors called, “potentially preventable deaths.” These were victims who, if they received definitive medical care sooner, likely would have survived.?

Despite our best efforts and years of refinement, the system we have in place today fails to save all of the lives that can be saved. A glaring example of this is the Pulse Nightclub shooting, where 16 of the 49 fatalities died of potentially survivable wounds (double the average found in the ACS study).?

To fully grasp the gravity of the issue, imagine that in every school shooting we’ve suffered over the last several decades we could have saved 15%-20% of the children and staff who died. So how do we make it happen??

Solving with a Simple Question

The ACS study came to a straightforward conclusion and solution. If we want to stop students, teachers, and other victims of active shooter incidents from dying of survivable wounds we need to do two things: 1) deliver immediate point of wounding care as soon as possible and; 2) rapidly evacuate those victims to a hospital before their time runs out.?

And it was while thinking about that conclusion statement that it hit me: cops– without realizing it– had already figured this out. And we can demonstrate it by asking a simple question: What do we do when a cop gets shot??Do we let them lay on the ground for 20 minutes waiting for EMS to arrive? Do we wait for the area to be declared a warm-zone so a rescue task force can go in and get them??

No. We render immediate lifesaving care, throw them in the back of a police car, and get them to the hospital as quickly as possible.?

And what if it were one of our children or family members? Would we let them lay on the ground for 30 minutes waiting for EMS to be “cleared into the warm zone” to treat them and get them out? Nope. We’d render immediate lifesaving care, drag them out, get them in the nearest police car, and get them to the hospital as quickly as possible.?

And that reality leads us to the final question: if that’s what we as cops would do for our sister/brother officers and families, then why aren’t we doing it for other people’s children and loved ones?

The simple answer: because that wasn’t the accepted best practice.?

But now that we know the best practices aren’t working, it’s our obligation to do better.??

Enter Survival+ for Schools

Survival+ for Schools was born out of the recognition that what we’re doing isn’t working. This non-profit, started by a successful businessman and grandfather from outside of the public safety silo, asked a question of the public safety thought leaders who were recruited onto the team: can we fix this and save these lives that continue to be needlessly lost?

The answer aligns with the findings of that ACS study. We can– if we ensure that the equipment and training are in place to deliver immediate point of wounding care and we provide for the rapid evacuation of victims to definitive medical care. Let’s take them one at a time.?

Immediate Treatment

The ACS study showed us that the vast majority of survivable wounds were not hemorrhaging wounds (only 6% of potentially preventable deaths) but, instead, non-hemorrhaging chest wounds (think tension pneumothorax). That means that while there’s value in tourniquets and bleeding control programs, the availability of valved chest seals has a much greater potential of buying time and saving lives.

To further increase the chances of success, we need the people closest to the victims (in both time and location) to be trained in how to administer immediate point of wounding care. This means teachers, staff, and where appropriate, the kids themselves.?

Getting them Out

While immediate point of wounding care adds time to the survivability clock, the area where we lose the largest number of savable victims is in the delays associated with transport to definitive medical care. This results in what are sometimes referred? to as “stage and wait” deaths.?

The Survival+ program changes the paradigm by ensuring that once an adequate number of contact officers/teams are dealing with the threat, the additional arriving and available officers engage in immediately evacuating the victims to casualty collection points. In the absence of on-scene EMS resources, the officers are given the option to transport the victims directly via police vehicles– the same as we’d do for a fellow officer in the same situation. The same as we’d want someone to do for our children if they were seriously wounded and time was of the essence.?

If EMS resources are available and on-scene, then they now have the ability to treat and transport long before the scene is declared a “warm zone” and treatment and evacuation would historically begin.?

Providing for immediate point of wounding care combined with rapid and timely evacuation to definitive medical care will, for the first time, create an active shooter response that gives every victim with survivable wounds the greatest chance at survival.?

Anything less is unacceptable.?

To learn more about the Survival+ for Schools program, visit https://survivalplusforschools.org

Smith ER, Sarani B, Shapiro G, Gondek S, Rivas L, Ju T, Robinson BR, Estroff JM, Fudenberg J, Amdur R, Mitchell R. Incidence and Cause of Potentially Preventable Death after Civilian Public Mass Shooting in the US. J Am Coll Surg. 2019 Sep;229(3):244-251. doi: 10.1016/j.jamcollsurg.2019.04.016. Epub 2019 Apr 25. Erratum in: J Am Coll Surg. 2021 Dec;233(6):816. PMID: 31029762.